Article

Thrombocytopenia in Infants and Children

Thomas Jefferson University, Philadelphia, PA, USA.
Pediatrics in Review (Impact Factor: 0.82). 04/2011; 32(4):135-49; quiz 150-1. DOI: 10.1542/pir.32-4-135
Source: PubMed

ABSTRACT • Thrombocytopenia should be suspected in any child presenting with a history of easy bruising or bleeding or petechiae, but it also may present as an incidental finding in an asymptomatic individual. • Thrombocytopenia may be caused by either increased destruction or removal of platelets from the circulation or decreased production of platelets. • Destructive mechanisms resulting in thrombocytopenia include immune-mediated destruction, platelet activation and consumption, mechanical platelet destruction, and platelet sequestration or trapping. • Impaired platelet production may be due to bone marrow infiltration, suppression, or failure or defects in megakaryocyte development and differentiation. • A thorough history and physical examination and judicious use of laboratory testing can lead to the appropriate diagnosis in most patients who have thrombocytopenia. • Childhood ITP generally presents with the sudden appearance of bruising, bleeding, or petechiae in an otherwise healthy child. • The diagnosis of ITP can be made using two criteria: 1) isolated thrombocytopenia with otherwise normal blood counts and peripheral blood smear and 2) no clinically apparent associated conditions that may cause thrombocytopenia. • Further evaluation, including bone marrow assessment, should be considered in patients who have atypical clinical or laboratory features at presentation; thrombocytopenia lasting more than 6 months; or a subsequent clinical course that is inconsistent with the natural history of ITP, including failure to respond to usually effective therapies. • Management of thrombocytopenia should be guided by an understanding of its cause and clinical course, with the principal goal in all patients being to maintain a safe platelet count to prevent significant bleeding. • For childhood ITP, pharmacologic intervention, including corticosteroids, IGIV, and anti-Rho(D) immune globulin, has been shown to raise the platelet count more quickly than no therapy and is recommended for children who have or at risk for severe or life-threatening bleeding, based on strong evidence. • ITP in children usually is short-lived, with at least two thirds of patients making a full and sustained recovery within 6 months of presentation, with or without treatment.

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